Alderman Harold, Nguyen Phuong Hong, Tran Lan Mai, Menon Purnima
Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, District of Columbia, USA.
FHI Solution, Hanoi, Vietnam.
Matern Child Nutr. 2021 Jul;17(3):e13179. doi: 10.1111/mcn.13179. Epub 2021 Mar 14.
Gender disparities in child undernutrition and mortality in India have been a topic of interest for a long time, but little is known on trends or geographic variability in recent periods. We examined the degree to which historic patterns in gender disparities in child undernutrition and mortality in India have persisted given recent progress in health and nutrition. Using two nationally representative datasets from India between 2006 and 2016, we estimated mortality rates and stunting by gender and by birth order among children under 5 years old. We then tested for differences between boys and girls within each survey round for both national and state levels using bootstrapped standard errors, controlling for cluster and sampling weights. We found striking progress in child mortality and stunting in India between 2006 and 2016 for both boys and girls. Boys were more likely to die than girls during the first year of life. Girls had a higher risk of mortality between age 1 and 5 years than boys in 2006, but the improvements in survival eliminated this gender gap in 2016. For stunting, we found no gender difference in 2006, but girls had higher height-for-age Z-scores (HAZ) and lower stunting than boys in 2016. Trends in gender gaps in mortality and stunting vary substantially by birth order and between states. Our findings indicate that improvements in mortality and nutritional status among girls have started to close gender disparities. Policy efforts to close gaps must stay the course in states that have made progress and be accelerated in states where disparities are still prominent.
印度儿童营养不良和死亡率方面的性别差异长期以来一直是人们关注的话题，但对于近期的趋势或地理差异却知之甚少。鉴于在健康和营养方面取得的最新进展，我们研究了印度儿童营养不良和死亡率方面性别差异的历史模式持续存在的程度。利用2006年至2016年期间印度两个具有全国代表性的数据集，我们估计了5岁以下儿童按性别和出生顺序划分的死亡率和发育迟缓情况。然后，我们使用自抽样标准误差，在国家和州层面的每一轮调查中检验男孩和女孩之间的差异，同时控制聚类和抽样权重。我们发现，2006年至2016年期间，印度男孩和女孩在儿童死亡率和发育迟缓方面都取得了显著进展。在出生后的第一年，男孩比女孩更有可能死亡。2006年，1至5岁年龄段女孩的死亡风险高于男孩，但到2016年，生存率的提高消除了这一性别差距。在发育迟缓方面，我们发现2006年不存在性别差异，但2016年女孩的年龄别身高Z评分（HAZ）更高，发育迟缓情况比男孩更轻。死亡率和发育迟缓方面的性别差距趋势因出生顺序和州而异。我们的研究结果表明，女孩死亡率和营养状况的改善已开始缩小性别差异。在取得进展的州，缩小差距的政策努力必须坚持下去，而在差异仍然突出的州，则必须加快推进。
